partograph.ppt_1

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Welcome to the

11th PLGPMI NationalGeneral Assembly

MIDWIVESMIDWIVES

Embracing DevelopmentEmbracing Development!oping "ith !hange!oping "ith !hange

Manila #otelManila #otel



G$$D M$%NINGG$$D M$%NING

PA%&$G%AP#PA%&$G%AP#Ma'e EasyMa'e Easy

LOURDES BORJALOURDES BORJA

MAGBANUA,MAGBANUA,

RM, RN, RT, MAN, Ph.DRM, RN, RT, MAN, Ph.D



PartographPartograph Ma'e EasyMa'e Easy

So(rce ) *asic Emergency $bstetric

!areDr+ ,ose -abella Memorial



I. The PartographI. The Partograph

►A tool to help in managementA tool to help in management

o/ laboro/ labor►G(i'es birth atten'ant toG(i'es birth atten'ant to

i'enti/y "omen "hose labor isi'enti/y "omen "hose labor is

'elaye' an' there/ore 'eci'e'elaye' an' there/ore 'eci'e

appropriate actionappropriate action



OBJECTIVESOBJECTIVES

I+I+ &o (n'erstan' the concept o/ the &o (n'erstan' the concept o/ theW#$ partographW#$ partograph

&o e0plain to mothers the &o e0plain to mothers the

signi/icance o/ the graphsigni/icance o/ the graph

II+II+ &o recor' the observations &o recor' the observationsacc(rately on the graphacc(rately on the graph

III+III+ &o interpret the recor'e' /in'ings &o interpret the recor'e' /in'ingsrecognie 'eviation /rom therecognie 'eviation /rom thenorm an' 'eci'e on timelynorm an' 'eci'e on timelyre/erralre/erral



Monitor during labor…Monitor during labor…

► Progress o/ laborProgress o/ labor !ervical 'ilatation!ervical 'ilatation

!ontraction pattern!ontraction pattern

► Maternal "ell beingMaternal "ell being P(lse temperat(re bloo'P(lse temperat(re bloo'

press(repress(re

2rine voi'e'2rine voi'e'

► -etal "ell being-etal "ell being -etal heart rate an' pattern-etal heart rate an' pattern

!olor o/ amniotic /l(i'!olor o/ amniotic /l(i'



The parts of the partographThe parts of the partograph

Progress of labor

Maternal and fetal wellbeing



!lert line

"I#!T

!TIO

$



!lert line !%tion line

"I#!T

!TIO

$

ParallelParallel

an'an' &&hours tohours to

the rightthe right o/ alerto/ alert

lineline



Conditions that doesConditions that does notnot needneed

the use of partographthe use of partograph

► Antepart(mAntepart(m

hemorrhagehemorrhage► Severe pre3eclampsiaSevere pre3eclampsia

an' eclampsiaan' eclampsia

► -etal 'istress-etal 'istress

► Previo(s cesareanPrevio(s cesarean

sectionsection

► M(ltiple pregnancyM(ltiple pregnancy

► MalpresentationMalpresentation► Very premat(reVery premat(re

babybaby

►

$bvio(s obstr(cte'$bvio(s obstr(cte'laborlabor



II. 'e%ording the findingsII. 'e%ording the findings

in the partographin the partograph

►Start by labeling the recor'Start by labeling the recor'

"ith pertinent patient"ith pertinent patienti'enti/ying in/ormation+i'enti/ying in/ormation+



Plotting the progress ofPlotting the progress of

laborlabor

►Plot only the !E%VI!ALPlot only the !E%VI!AL

DILA&A&I$N (sing the symbolDILA&A&I$N (sing the symbol ()*()*

►Start "hen "oman is in A!&IVEStart "hen "oman is in A!&IVE

LA*$% 45 cmLA*$% 45 cm or +oreor +ore6 an' is6 an' is

contracting a'e7(ately 4835contracting a'e7(ately 4835

contractions in 19 min(tes6contractions in 19 min(tes6



)

Start plottingStart plotting on alert line inon alert line inthe interse%tionthe interse%tion correspon'ing cervicalcorrespon'ing cervical

'ilatation /in'ing'ilatation /in'ing



)



)5pm

In'icate the time the IE "as ma'eIn'icate the time the IE "as ma'e

4an' there/ore the observation "as4an' there/ore the observation "as

plotte'6plotte'6 Write this in the vertical line itsel/Write this in the vertical line itsel/

"here yo( plot the"here yo( plot the ()*()* N$& the space N$& the space



)

)

)

5pm :pm 19pm

Per/orm internal e0aminationPer/orm internal e0amination

every 5 ho(rs or more o/ten i/every 5 ho(rs or more o/ten i/necessary an' plot /in'ings eachnecessary an' plot /in'ings eachtimetime

Also 'o not /orget to "rite the timeAlso 'o not /orget to "rite the timeeach observation "as ma'eeach observation "as ma'e



)

)

)

5pm :pm 19pm

!onnect the!onnect the ()*s()*s toto'emonstrate the pattern o/'emonstrate the pattern o/

laborlabor



1am

E)!MP#EE)!MP#E

A G1P9 is being monitore' byA G1P9 is being monitore' bya mi'"i/e at home+ #er initiala mi'"i/e at home+ #er initial

IE at 1 am sho"e' 5 cmIE at 1 am sho"e' 5 cm

'ilate' cervi0+'ilate' cervi0+

,



1am ;am

,

,

E)!MP#EE)!MP#E

At ; am another IEAt ; am another IEsho"e' : cm 'ilate' cervi0+sho"e' : cm 'ilate' cervi0+



1am ;am

,

,

E)!MP#EE)!MP#E

At < am the patient is =At < am the patient is =cm 'ilate' station 31cm 'ilate' station 31

intact *$W+intact *$W+

<am

,



)

)

)

5pm >pm :pm 19pm

Progress o/ labor isProgress o/ labor is nor+alnor+al i/i/

plottingplotting sta-s on or to thesta-s on or to the

left of the alert lineleft of the alert line greengreen

part/part/

)

)



)

)

)

5pm >pm :pm 19pm

Note that base' on the str(ct(reNote that base' on the str(ct(re

o/ the partograph as soon as 5o/ the partograph as soon as 5

cm is reache' the cervi0 sho(l'cm is reache' the cervi0 sho(l'

'ilate'ilate nor+all-nor+all- at a rate o/at a rate o/ 0 10 1

%+2hour%+2hour++



)

)

5pm >pm :pm 19pm

Plotting thatPlotting that passes the alertpasses the alert

lineline -ellow part/-ellow part/ more somore so if itif it

rea%hes or passes the a%tionrea%hes or passes the a%tion

lineline red part/red part/ in'icatesin'icates

abnor+alabnor+al progress o/ laborprogress o/ labor

)

1?am ?am



If plottingIf plotting passes alertpasses alert

lineline ……

►'eassess wo+an and %onsider'eassess wo+an and %onsider

referral if fa%ilities are notreferral if fa%ilities are nota3ailable to deal with obstetri%a3ailable to deal with obstetri%

e+ergen%ies4 unless deli3er- ise+ergen%ies4 unless deli3er- is

i++inenti++inent►!lert transport ser3i%es!lert transport ser3i%es

►Monitor intensi3el-Monitor intensi3el-



5hat to do if partograph

passes alert line ► 'eassess wo+an and %onsider %riteria forreferral.

► !lert transport ser3i%es.► E+pt- bladder.► Ensure ade6uate h-dration but o+it solid

foods.► En%ourage upright position and wal7ing if

wo+an wishes.

► Monitor intensi3el-. If referral long4reassess in 8 hours and refer if no progress.

If partograph passes a%tion line4 refer

urgentl- to an E+OC fa%ilit- unlessi++inent deli3er .



If plotting rea%hes theIf plotting rea%hes the

a%tion linea%tion line……

the patient m(st be alrea'ythe patient m(st be alrea'y

in an Em$! /acility ain an Em$! /acility a

'ecision ma'e abo(t the'ecision ma'e abo(t theca(se o/ slo" progress an'ca(se o/ slo" progress an'

appropriate action ta@enappropriate action ta@en



The parts of the partographThe parts of the partograph

Progress of labor

Maternal and fetal wellbeing



IV. Other findings to noteIV. Other findings to note

and re%ord/ during IEand re%ord/ during IE

►Stat(s o/ membranesStat(s o/ membranes writewrite

(( I *I * i/ intacti/ intact

►I/ r(pt(re' note color o/ amnioticI/ r(pt(re' note color o/ amniotic/l(i'/l(i' writewrite

(( C *C * i/ cleari/ clear

(( M *M * i/ meconi(m staine'i/ meconi(m staine'

(( ! *! * i/ absenti/ absent

(( B *B * i/ bloo'yi/ bloo'y



Monitor e3er- & hoursMonitor e3er- & hours

and re%ord the findingsand re%ord the findings►*loo' Press(re*loo' Press(re

►P(lse rateP(lse rate► &emperat(re &emperat(re

►2rine voi'e' 4yes or no62rine voi'e' 4yes or no6

More /re7(ently i/ in'icate'



Monitor +ore fre6uentl-Monitor +ore fre6uentl-

and re%ord the findingsand re%ord the findings

►

N(mber o/ contractions inN(mber o/ contractions in

19 min(te perio'19 min(te perio'

►-etal heart rate in 1 /(ll-etal heart rate in 1 /(ll

min(temin(te



I/ "oman is a'mitte' in LA&EN&I/ "oman is a'mitte' in LA&EN&P#ASE o/ labor 4less than 5 cmP#ASE o/ labor 4less than 5 cm

'ilate'6 B recor' only other'ilate'6 B recor' only other

/in'ings 4*P -#& etc6+/in'ings 4*P -#& etc6+

I/ she remains in latent phaseI/ she remains in latent phase

/or ne0t : ho(rs 4labor is/or ne0t : ho(rs 4labor isprolonge'6 trans/er her toprolonge'6 trans/er her to

hospital+hospital+



E)E'CISESE)E'CISES

►In'icate "hether the progress o/In'icate "hether the progress o/

labor in the /ollo"ing partographslabor in the /ollo"ing partographs

are normal or abnormal+are normal or abnormal+



,

?am

,

19pm

Case 1



,

)

)

=pm 1am 8am

Case 9



E)E'CISESE)E'CISES

►Plot the observations in thePlot the observations in the

/ollo"ing cases+/ollo"ing cases+



Case &:Case &:

A G?P1 "as a'mitte' at ? am IEA G?P1 "as a'mitte' at ? am IEsho"e' a 5cm 'ilate' cervi0+ &hesho"e' a 5cm 'ilate' cervi0+ &he

patient "as still smiling an' she "aspatient "as still smiling an' she "as

hesitant to be a'mitte'+hesitant to be a'mitte'+

At > am another IE "as 'one C : cmAt > am another IE "as 'one C : cm

'ilate' cervi0 :9 e//ace' station'ilate' cervi0 :9 e//ace' station

9+9+

At : am /etal hea' "as b(lging at theAt : am /etal hea' "as b(lging at the

perine(m+perine(m+



)?am >am

)

)

:am

!nswer

to %ase&



);pm

=pm

)

1am

)

!nswer

to %ase;



'EC!P►Signi/icance an' (se o/ the partograph

►Parts o/ the partograph an'in/ormation containe' in it

►%ecor'ing or plotting o/ clinicalobservations

►Interpretation o/ the recor'e' /in'ingsan' 'ecision on re/erral



%emember this my 'ear Mi'"ives%emember this my 'ear Mi'"ives

AA ob title alone ob title alone 'oes not ma@e a person'oes not ma@e a person

a lea'er+a lea'er+$nly a$nly a personFs behaviorpersonFs behavior 'etermines i/'etermines i/

he or she occ(pies a lea'ership position+he or she occ(pies a lea'ership position+



-ello" Mi'"ives-ello" Mi'"ives!olleag(es Goo' 'ay .!olleag(es Goo' 'ay .

!ongrat(lations !ongrat(lations

partograph.ppt_1

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